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General NPI Number Information
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NPI Number | 1811254493
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Entity Type | Organization
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Legal Business Name | SOUTHMOORE PHARMACY LLC
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 2453 PLAZA CT STE A
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City | BATH
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State | PA
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Zip | 18014-8762
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Country | US
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Telephone | 484-287-6337
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Fax | 484-287-6340
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Provider Business Mailing Address
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Address Line | 2453 PLAZA CT STE A
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City | BATH
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State | PA
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Zip | 18014
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Country | US
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Telephone | 484-287-6337
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Fax | 484-287-6340
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Authorized Official
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Title or Position | PARTNER
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Name | DAWN WEBER
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Credential |
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Telephone | 484-287-6337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP482196
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License Number State | PA
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